MIPS updates

Change is Coming for MIPS Year 3 in 2019

A new year approaches, along with updates to the Merit-based Incentive Payments System (MIPS). In November, the Centers for Medicare & Medicaid Services (CMS) released the MIPS Year 3 scheduled updates that will go into effect on January 1, 2019. It’s essential for orthopaedic practices to familiarize themselves with the major changes if they want to secure their largest possible payment adjustment from CMS. Read on to discover how changing regulations may affect the data you wish to collect throughout year 3.

Performance Thresholds

In 2019, the performance threshold will go from 15 to 30 points to ensure a neutral payment adjustment, with the additional performance threshold increasing to 75 points, a 5-point increase from the previous reporting year. A third standard will be added to meet MIPS exclusion criteria; providing 200 or fewer covered professional services under the Physician Fee Schedule will exclude practices from participation. Providing care to 200 or fewer beneficiaries or having $90,000 or less in Part B allowed charges for covered professional services will also still exclude physicians and groups from MIPS participation.

Additionally, there is a new Opt-In policy for MIPS in effect for 2019. Physicians and groups are eligible to opt in to MIPS if they meet or exceed at least one of the low-volume threshold criteria, but not all of them. Once opted-in, you cannot reverse your participation choice for the reporting year.

Small Practice Flexibility

The updates continue to provide small practice bonuses in 2019; however, it will be included within the Quality category as of January 1. The bonus itself increased to 6 points if a physician submits data on at least one measure within the Quality category, and small practices will continue to be eligible for at least three points for quality measures that do not meet data completeness standards.

Performance Category Updates

The newly re-organized Promoting Interoperability category involves the following four objectives: E-prescribing, Health Information Exchange, Provider to Patient Exchange, and Public Health and Clinical Data Exchange. In 2019, providers are required to report certain measures from each objective.

In 2019, the final score weights of Quality and Cost will also change. The Quality category is now weighted at 45 percent of the final score (down from 50 percent in 2018). Subsequently, the Cost category has been increased to 15 percent of the final score.

These are just a few of the changes that CMS intends to implement in the new year. Complete details can be found on the Quality Payment Program website for 2019. Ever-changing regulations can make MIPS challenging to keep up with. That’s why Exscribe will be offering a new MIPS Monitoring Program beginning January 1, 2019 to assist practices in obtaining their maximum score, in addition to keeping our subscribers updated with the latest information in EHR news.